Abstract P148: Ambulatory Blood Pressure in Hypertensive Patients Treated with Different 2-Drug and 3-Drug Combinations

Abstract

An elevated proportion of patients require 2-drug and 3-drug combinations to achieve BP control. There is scarce evidence regarding if there are differences in such BP control among different types of combinations in daily practice. We aimed to assess office and ambulatory BP values achieved, as well as the proportion of controlled patients, depending on the type of drug combination used. From the Spanish ABPM Registry we selected 17187 patients treated with the 6 most common types of 2-drug combinations and 9724 treated with the 6 most common types of 3-drug combination. We looked for differences in achieved office and ambulatory BP, as well as nocturnal dip, and the proportion of controlled patients among types of combinations, after adjusting for confounders (age, gender, BMI, smoking, diabetes, dyslipidemia, and previous CV disease). With respect to the combination of renin angiotensin system (RAS) blockers and diuretics (reference), none of the other combinations achieved lower BP values or better BP control. Ambulatory BP control (including 24-hour, daytime and nighttime) was worse with combinations of RAS blockers/beta blockers (OR: 1.06; 95%CI: 1.01-1.11), with combinations of calcium channel blockers (CCB)/beta blockers (1.1; 1.04-1.16) and with combinations of RAS blockers and CCB (1.38; 1.23-1.55). Nondipping was also more frequent in combinations other than RAS blockers/diuretics. In patients receiving 3-drug combinations, and with respect to RAS blockers/CCB/diuretic combinations (reference), ambulatory BP were higher and non dipping more frequent in other types of combinations. Ambulatory BP control was worse in RAS blockers/CCB/alpha blockers, RAS blockers/diuretics/alpha blockers, and CCB/beta blockers/diuretics combinations. No differences in office BP control were observed among types of 2-drug or 3-drug combinations. We conclude that RAS/diuretic combinations and RAS/diuretic/CCB combinations are associated with better ambulatory BP control and more pronounced dipping in comparison with other types of 2-drug or 3-drug combinations, even with same rates of office BP control. These results can be helpful in deciding the way to combine antihypertensive agents in patients who require combination therapy.